Acutrak 나사를 이용한 요골두 골절의 치료 -7례 보고-

김광열,임문섭,신흥섭,최신권,Kim, Kwang-Yul,Lim, Moon-Sup,Shin, Heung-Sub,Choi, Shin-Kwon 대한정형외과스포츠의학회 2006 대한정형외과스포츠의학회지 Vol.5 No.1

목적: 해부학적 정복이 가능한 요골두 골절에 대하여 Acutrak 나사를 이용한 고정술의 치료 결과와 유용성에 대해 알아보고자 하였다. 대상 및 방법: 2001 년 5월부터 2003년 2월까지 본원에서 요골두 골절에 대해 수술한 12 예중 Acutrak 나사 고정술로 치료한 7 예를 대상으로 하였다. 추시 기간은 최소 6개월부터 최장 30개월로 평균 1.2년이었고, 평균 나이는 47세였다 손상의 원인은 낙상이 4예, 교통사고가 3예이었다. 치료 결과 평가 방법은 Mayo Clinic에서 발표한 Functional Rating index를 이용하였다 결과: Mayo Clinic의 Functional Rating Index를 이용한 기능적 평가상 우수가 2예, 양호가 5예였다 방사선학적 소견 상 모든 예에서 골유합 소견을 보였고, 부정 유합이나 나사 이완, 이소성 골형성, 감염, 외상 후 퇴행성 변화 등의 합병증은 없었고 수술 후 건측과 비교하여 운동장애도 보이지 않았다. 결론: 본원에서 시행한 요골두 골절의 Acutrak 나사 고정은 요골두 부분의 안전지대에 대한 고려없이 시행 가능하며 방사선학적 및 임상적 평가에서 만족할 만한 결과를 보였고, Acutrak 나사의 형태학적 특성상 골절의 선상 형태에 대하여 근위 요척골관절에 영향을 주지 않으며, 강한 고정력을 얻을 수 있는 술식으로 사료된다. Purpose: To evaluate the efficiency of Acutrak screw fixation for radial head fracture (Mason type 2) without considering the safe Bone of radial head. Materials and Methods: Consecutive seven radial head fracture of Mason type II underwent internal fixation with Acutrak screws from May 2001 to February 2003. The mean follow-up period was 1.2years (ranged, $6 months{\sim}2.5 years$). The mean age of patients was 47 years old (ranged, $36{\sim}60years$ old). The cause of injury were fall down -4 cases and traffic accident -3 cases. The results were evaluated by Mayo Clinic results scoring system. Results: Functional Rating Index of Mayo Clinic was excellent- 2 cases and good- 5 cases. There were no nonunion, loosening, heterotopic ossification, infection or degenerative changes. The postoperative range of motion in elbow joint is nearly full for flexion, extension, pronation and supination in this study Conclusion: Consideration of safe zone is not necessary when Acutrak screws are used for radial head fracture. It seems to be a useful method that Acutrak screw fixation for radial head fracture (Mason type II) could achieve good radiologic and clinical results without influencing proximal radio-ulnar joint and has powerful fixation.

Reverdin 절골술을 이용한 무지외반증의 치료

강재도,김광열,임문섭,박현수,Kang, Jae-Do,Kim, Kang-Yul,Lim, Moon-Sup,Park, Hyun-Soo 대한족부족관절학회 2002 대한족부족관절학회지 Vol.6 No.1

Authors studied 24 cases in 18 patients with the hallux valgus deformity treated by Reverdin osteotomy at Department of Orthopaedic Surgery, Wallace Memorial Baptist Hospital from January 1995 to December 1999. Reverdin osteotomy is one of the distal metatarsal osteotomies in the treatment of hallux valgus in adults. We performed Reverdin osteotomy on 24 cases (18 patients) for painful hallux valgus associated with an increased hallux valgus angle (> 35degrees) and first-second intermetatarsal angle(>13 degrees). The results were as follows. 1. The average first-second intermetatarsal angle was 16.8 degrees and average valgus angle was 37.3 degrees, preoperatively. they were corrected to 7.8 degrees and 12 degrees respectively. 2. The metatarsalgia of the great toe was subsided in all cases and they were satisfied with the result of their operations in respect to cosmetically and functionally. Avascular necrosis of capital fragment, nonunion, and dorsal angulation were not developed in any case. But one case had superficial wound infection and delayed union, presumably due to secondary infection.

외상성 만성 비골건 탈구의 수술적 치료 (1예 보고)

이도영,강재도,임문섭,윤형조,Lee, Do-Young,Kang, Jae-Do,Lim, Moon-Sup,Yoon, Hyeong-Jo 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.1

Traumatic dislocation of the peroneal tendon is an infrequent injury. This injury is caused by forceful dorsiflexion of the foot accompanied by a powerful contraction of the peroneal muscles. This mechanism of injury tears the superior peroneal retinaculum and allows the tendons to snap anteriorly. We experienced a case of chronic recurrent dislocation of the peroneal tendon, which was treated by bone block surgery using autograft of lateral fibula and reattachment of the superior peroneal retinaculum. The clinical result was satisfactory.

생인손을 동반한 경피증 환자의 말단골용해

황인환(In Hwan Hwang),임문섭(Moon Sup Lim),김광열(Kwang Yul Kim),김형천(Hyung Chun Kim),문상호(Sang Ho Moon),이지훈(Ji Hoon Lee),조성준(Sung Joon Cho) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.1

경피증(scleroderma)은 피부 및 전신의 결체 조직에 교원질이 과도하게 침착하고 미세혈관의 병변으로 가끔씩 말단골용해(acroosteolysis)을 동반하기도 한다. 말단골용해는 수족지 말단의 기저부는 유지된 채로 골파괴 또는 골용해가 발생되는 현상으로 대부분의 말단골용해는 경피증을 포함하는 결체조직 질환에서 혈류순환 장애로 인해 이차적으로 발생되는 것으로 알려져 있으나, 연부 조직의 궤양이나 부분적인 감염 및 골수염에 의해서도 발생 가능하다고 한다. 경피증을 가진 환자들은 결체 조직의 이상으로 미세혈관의 폐쇄, 피하조직의 소실, 건조하고 비후된 피부 및 면역체계의 이상 등으로 사지 밀단부에 생인손(felon) 및 피부 궤양과 같은 감염이 지속적으로 나타나기 쉽다. 저자들은 생인손을 주소로 내원하여 경피증으로 진단된 환자에게서 말단골용해 1예를 경험하였기에 이를 보고하는 바이다. The Scleroderma is a chronic inflammatory disease of the connective tissue with involvement of the skin and other organs. It can be a manifestation of various disorders and occasionally acroosteolysis in the phalanges. Acroosteolysis is characterized by bone resorption or destruction in the phalanges, while the base is preserved. The pathogenesis of acroosteolysis in patients with scleroderma is a blood-flow disorder that is mainly associated with an abnormal accumulation of collagen in all tissues, microangiopathy and infections in the phalanges. The phalanges in patients with scleroderma are prone to continuous infections as a felon or skin ulcers due to atrophy of the subcutaneous tissue, dry and sclerotic skin, or a disorder of the immune system. We experienced a patient who had acroosteolysis with scleroderma of the phalanges, and this was associated with a felon. We report on this case along with a brief review of the literature.

족관절 삼과 골절과 동반된 장 비골건 탈구(1예 보고)

황인환,김광열,김형천,임문섭,이지훈,조성준,Hwang, In-Hwan,Kim, Kwang-Yul,Kim, Hyung-Chun,Lim, Moon-Sup,Lee, Ji-Hoon,Cho, Sung-Jun 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.2

Traumatic dislocation of the peroneus longus tendon is an often unrecognized injury which has been reported to occur most commonly during sports activity. Most acute cases with early detection can be treated by simple repair of the tendon or retinaculum using one of several procedures available. Accurate treatment through a comprehensive evaluation of the ankle injury prevents suboptimal and sometimes unrecorrectable outcomes. The authors experienced concomitantly the peroneus longus tendon dislocation associated with a trimalleolar fracture of the ankle. We report this case a brief review of the literature.

생체흡수성 나사못을 이용한 원위경비관절 이개의 치료

강재도,김광열,김형천,임문섭,김진형,김성훈,Kang, Jae-Do,Kim, Kwang-Ryul,Kim, Hyung-Chun,Lim, Moon-Sup,Kim, Jin-Hyung,Kim, Seong-Hoon 대한족부족관절학회 2003 대한족부족관절학회지 Vol.7 No.1

Purpose: Bioabsorbable screws are used to fix the syndesmotic injury of ankle because of no need for additional operation to remove it. The purpose of this study is to assess the efficacy of polylevolactic acid (PLLA) screws of in the treatment of the syndesmotic injury of ankle. Materials and Methods: Eight patients of the syndesmotic injury of ankle with malleolar fracture were evaluated in this study. They were managed with plate and screw fixation for malleolar fracture and polylevolactic acid screw fixation for syndesmotic injury, followed by plaster splinting for 6 weeks. Clinical and radiographic evaluation were done and functional scores were assessed. Results: In all cases, malleolar fractures were healed without problematic widening of syndesmosis. There were no sinus tract formation and no wound complication. Of eight patients, five had excellent results and three had good results. Conclusion: We conclude that polylevolactic acid screw is good material for fixation of the syndesmotic injury of ankle.

관절경적 Bankart 봉합술후 적극적 재활치료 - 전향적 임상연구 -

김승호,하권익,정민욱,임문섭,김영민,박종혁,조양범,Kim Seung-Ho,Ha Kwon-Ick,Jung Min-Wook,Lim Moon-Sup,Kim Young-Min,Park Jong-Hyuk,Cho Yang-Bum 대한정형외과스포츠의학회 2002 대한정형외과스포츠의학회지 Vol.1 No.1

목적 : 관절경적Bankart 봉합술후조기운동과일반적인고정법의임상결과를전향적방법으로비교하고자하였다. 대상및방법 : 외상성재발성전방불안정성이있는62명의환자를대상으로봉합나사를이용하여관절경적 Bankart 봉합술을시행후, 2개의무작위그룹으로분류하였다. 그룹1(28명, 평균나이28세)은3주동안고정한뒤고식적인재활운동을시작하였고그룹2(34명, 평균나이29세)는단계적인관절운동및근력강화운동으로구성된적극적재활운동을수술다음날부터시작하였다. 환자선택의기준은재발성불안정성이있으며전형적인Bankart 병변을가진비운동선수를대상으로하였으며평균31개월동안추시관찰하였다. 결과는통증점수, 관절운동범위, 일상생활로의회복, 재발율, 각재활프로그램에대한환자의만족도그리고shoulder score (ASES, UCLA and Rowe)를분석하였다. 결과 : 두그룹간재발율의차이는없었으며, 어느그룹에서도재발성탈구는나타나지않았다. 각각의그룹에서2명의환자에서전방불안유발검사에서양성소견을나타냈다. 적극적재활치료를한환자는기능적관절운동이더빨랐으며활동의기능적인면에서도더빨리회복되었다. 적극적재활치료를한경우에는술후통증은감소하였고, 재활프로그램에만족하고있으나shoulder scores, 일상생활로의복귀, 통증점수그리고관절운동범위는최종추시시, 두그룹간차이는없었다.결론 : 조기재활은관절경적Bankart 봉합술후선택적환자군에서재발율은증가하지않았다. 두그룹간최종결과는동일하였지만적극적재활운동은기능적회복을촉진하고술후통증을감소시켜일상생활로의빠른복귀가가능하였다. Purpose: In this prospective, randomized study, we compared the results of early motion versus conventional immobilization after the arthroscopic Bankart repair. Materilal and Methods : We performed an arthroscopic Bankart repair using suture anchors in 62 patients with traumatic anterior shoulder instability and randomized them into two groups; Group 1 (n=28; mean age, 28 years) underwent three-week of immobilization and conventional rehabilitation program, while Group 2 (n=34; mean age, 29 years) underwent an accelerated rehabilitation program with staged range of motion and strengthening exercises starting from the immediate postoperative day. Selected patients were non-athletes with a classic Bankart lesion and a robust labrum. Analysis of outcome included pain scores (6-week and follow-up: 31(9 months), range of motion, return to activity, recurrence, patients’ satisfaction with each program, and shoulder scores (ASES, UCLA, and Rowe). Results : The recurrent rate was not different between the two groups (2 anterior apprehension from each group) (p=0.842). Patients with accelerated rehabilitation resumed functional range-of-motion faster and returned earlier to the functional level of activity (p<0.05). Accelerated rehabilitation decreased postoperative pain and more patients were satisfied with this program (p<0.05). No differences were found between the two groups at the follow-up with regards to the shoulder scores, return to activity, pain score, and the range-of-motion. Conclusions : Early mobilization after arthroscopic Bankart repair does not increase the recurrence rate in selected patients. Although the final outcomes are similar in both groups, the accelerated rehabilitation program promotes functional recovery and reduces postoperative pain, which enables patients an early institution of desired activities.

변경된 교합성 골수강내 금속정을 이용한 전완부 간부 골절의 치료

김광열 ( Kwang Yul Kim ),임문섭 ( Moon Sup Lim ),최신권 ( Shin Kwon Choi ),윤형조 ( Hyeong Jo Yoon ) 대한골절학회 2008 대한골절학회지 Vol.21 No.2

목적: 전완부 간부 골절의 치료에 있어서 변경된 교합성 골수강내 금속정 (Acumed, Hillsbrough, IN, USA) 고정술의 효용성을 알아보고자 한다. 대상 및 방법: 2003년 12월부터 2007년 2월까지 요골, 척골, 요척골 간부 골절환자에게 Acumed에서 만든 변경된 교합성 골수강내 금속정을 사용해 고정술을 시행한 15예를 대상으로 하였다. 추시기간은 평균 8.3개월이었으며, 여자 7예, 남자 8예였다. 사용한 교합성 골수강내 금속정은 원위부가 납작하여 골속에 박히게 되어 있어 상용의 교합성 금속정에 비해 수술술기와 시간, 절개범위 등에 있어 장점을 가지고 있었다. 수술방법은 상용의 방법과 동일했으며 단지 원위부 나사못 고정이 필요없었으며, 근위부 나사못 고정만을 시행했다. 술 후 골유합 시기 및 Anderson에 의한 기능적 결과로 평가를 시행하였다. 결과: 골유합은 요골평균 9.8주 척골평균 11.4주에 이루어졌으며, 회외전 평균 74.6도, 회내전 평균 72도였다. 임상적 평가에서 우수 12예, 만족 3예였으며, 지연유합, 불유합, 신경혈관 손상, 감염 등의 합병증은 전예에서 관찰되지 않았다. 결론: 변경된 교합성 골수강내 금속정 고정술은 전완부 간부 골절의 치료에 있어 많은 장점을 가지고 있는 치료법의 하나라고 사료된다. Purpose: To evaluate the result of forearm shaft fracture treated by modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA). Materials and Methods: 15 patients with fracture of radius, ulna, radio-ulna shaft treated by modified interlocking intramedullary nail from December 2003 to February 2007 were analyzed. Modified interlocking intramedullary nail has paddle blade tip and fluted rod, so the distal screw fixation was not needed but had relatively firm fixation. It has advantages including short operation time, small operation scar. The average follow up period was 8.3 months (range, 5~15 months). We analyzed the results by average union time and the functional results according to Anderson`s criteria. Results: The mean duration of union was 9.8 weeks in radius and 11.4 weeks in ulna. The average range of motion of forearm was 74.6 degree in supination and 72 degree in pronation.. Functional results assessed by Anderson were rated excellet in 12 cases, satisfactory in 3 cases. We found no complications such as delayed union, non-union, neurovascular injury and infection. Conclusion: Modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA) is a viable therapeutic alternative in the management of forearm shaft fracture.

Acutrak 나사를 이용한 척골 주두 골절의 치료

김형천 ( Hyung Chun Kim ),김광렬 ( Kwang Ryul Kim ),임문섭 ( Moon Sup Lim ),박영일 ( Young Il Park ),황인환 ( In Hwan Hwang ),이지훈 ( Ji Hoon Lee ) 대한골절학회 2009 대한골절학회지 Vol.22 No.4

목적: 척골 주두 골절의 수술적 치료에서 Acutrak 나사를 이용한 내고정술 후 임상적 결과를 분석하기 위하여 본 연구를 시행하였다. 대상 및 방법: 본원에서 2003년 2월부터 2007년 9월까지 Acutrak 나사를 이용한 내고정술을 시행한 척골 주두 골절 15예에 대하여 12개월에서 42개월까지 추시 관찰하였다. 골절의 분류는 Mayo 분류를 이용하였다. 방사선학적 평가는 계단 변형, 관절면의 간격 그리고 정복 소실에 의거하여 판정하였고, 기능적 평가는 주관절의 동통 유무와 관절 운동범위 등을 기준으로 한 Helm 등의 판정기준을 이용하였다. 또한 골유합의 시기, 수술 시간, 수술 시 절개범위 등을 분석하였다. 결과: 본술식을 시행한 총 15예에 대한 기능적 결과분석에서 Mayo 분류 IA형 3예 중 우수가 3예이었으며, IIA형 10예 중 우수가 8예, 양호가 2예이었고, IIB형 2예 중 양호 1예, 불량 1예였다. 방사선학적 평가에서 IIB형 1예를 제외한 나머지 14예에서는 2 mm 이상의 계단 변형이나 정복 소실은 없었다. 평균 골유합 기간은 9.4주였다. 평균 수술 시간은 28분이었으며, 평균 절개범위는 1.8 cm 이었다. 결론: 척골 주두 골절의 치료 시 Mayo 분류 IA형과 IIA형에 대하여 Acutrak 나사를 이용한 내고정술이 고려할 수 있는 방법 중의 하나로 생각된다. Purpose: To evaluate the clinical results of Acutrak screw fixation for ulnar olecranon fractures. Materials and Methods: We reviewed 15 cases of ulnar olecranon fractures which were treated with Acutrak screws from February 2003 to September 2007. Follow-up period is from 12 months to 42 months. We used Mayo classification. Radiologic results were analyzed according to step-off, gap, reduction loss, and functional results were analyzed according to pain and ROM. We analyzed union time, operation time, incision size and complications. Results: In functional results, there were 3 good cases out of 3 Mayo type IA, 8 good cases and 2 fair cases out of 10 type IIA, 1 fair case and 1 poor case out of 2 type IIB. In radiologic results, there was 1 case of reduction loss. Average union time was 9.4 weeks, average operation time was 24 minutes and average incision size was 1.8 cm. Conclusion: We conclude that Acutrak screw fixation can be a treatment option for olecranon fracture of Mayo type IA and IIA.

원위 대퇴골 관절내 골절에서의 MRI촬영의 유용성

김형천 ( Hyung Chun Kim ),김광열 ( Kwang Ryul Kim ),임문섭 ( Moon Sup Lim ),이성주 ( Seong Joo Lee ),이도영 ( Do Young Lee ) 대한슬관절학회 2003 대한슬관절학회지 Vol.15 No.2